I am a reading specialist at a K-4 building. I work with students who are considered to be "at risk" in reading. I have a second grade girl about whom I have a question. She is an average student in math and in reading with average comprehension and silent reading fluency. However, her oral reading fluency is very low. She reads only 2-3 words at a time and stumbles through letter sounds. She also still reverses her b's and d's. However, even after reading in this manner, she is successful in reading comprehension. She reads with her parents at home every night and had a tutor over the summer. Although she is showing slight improvements, the improvements are not what one would expect with these interventions. Do you think dyslexia is a possibility?

Dr. Pierson's Response: 

Good for you to have concerns about this student. First, while reversals of letters are not diagnostically significant in determining dyslexia, the literature is clear that the persistence of letter reversals beyond 2nd grade is a red flag. So, she is at the cups of this being significant and at risk for dyslexia.

What is potentially significant is the slowness of her oral reading rate, which is related to rapid automatic naming (RAN). Naming speed has been found to be closely related to sight word recognition, reading rate, and orthographic knowledge (i.e., understanding and facility with letter patterns and spelling rules). We can see dyslexics who have stronger phonological awareness skills, but poor RAN skills. Ultimately, they learn letter-sound correspondences and spelling rules in order to become successful readers, but their slow reading rate persists.

I have found that one of the best tests to help determine the role of automaticity in reading is the Test of Word Reading Efficiency - 2 (TOWRE-2). The student reads real and nonsense word lists in a 45 second time limit. When administering this test, we can analyze whether a) the student is inaccurate (i.e., has poor phonemic awareness skills and orthographic knowledge); or b) is accurate, but slow (i.e., has difficulty with RAN) or c) both. A child with poor PA skills who has had intervention may be accurate on the real words, since she has learned them. But, and this is where the rubber meets the road, when confronted with nonsense words, her ability to read the word (i.e., decode) collapses because her letter-sound knowledge is not solidified. Given that you say she struggles with decoding in addition to speed, this test might be just the ticket in helping you pinpoint where her problems are stemming from.

Another helpful measure to determine how rate is impacting her reading is the Gray Oral Reading Test - 5 (GORT-5). Many times I see students who, despite obvious challenges decoding the text and a very slow rate, are able to make sense of the test and answer comprehension challenges because of their strong underlying spoken language skills. Given that reading, spelling, and writing are undergirded in spoken language, it is not unusual to see the student who struggles with decoding and fluency, but can understand the text. This is why audiobooks are so important for these students.

So, this girl may very well be dyslexic. A good diagnostician should be able to tease that out. That said, if she's had intervention, it can be trickier because we know that intervention works. As I'm sure you know, we look for a pattern of strengths and weaknesses using spoken language comprehension as the benchmark for strengths to then compare skills in written language.

I'm impressed that you took the time to inquire on behalf of this student.